Prescription opioid abuse has emerged as a significant public health problem in the United States in recent years, with rates of use second only to marijuana and greater associated mortality than both heroin and cocaine. Opioids are a front-line treatment for chronic pain and although many patients are able to adhere to prescribed medication regimens, between 30-50% will eventually abuse these medications. Given the need to adequately treat chronic pain, individuals with pain conditions are particularly vulnerable to the development of prescription opioid abuse, highlighting the importance of the identification of risk factors for opioid abuse in this population. Early research in this area has begun to identify risk factors for prescription opioid abuse in pain patients to facilitate monitoring, early detectin, and intervention. However, little is known at this time about risk factors that may predispose chronic pain patients to opioid abuse and few studies have examined potential mechanisms by which this may occur. A history of other substance use disorders has been the strongest predictor of prescription opioid abuse to date; yet, this is likely attributable to a shared vulnerability factor that may generally increase risk for harmful substance use patterns. The proposed study aims to examine such a factor that may confer risk for opioid abuse in chronic pain patients. Specifically, this study will examine whether distress intolerance--an important vulnerability factor in substance use disorders--is associated with prescription opioid abuse in chronic pain patients. Distress intolerance, the perceived inability to tolerate negative physical and emotional states, is an important risk and maintaining factor in substance use disorders that is associated with levels of use, motivation for use, presence of substance use disorders, and treatment outcome. Distress intolerance is a powerful motivator of harmful avoidance behaviors (e.g., substance use) that provide strong and immediate relief from distressing states. For someone who is highly intolerant of distress, behaviors that provide rapid reduction of distress become relied upon to regulate distress in the absence of alternative strategies. In chronic pain, the inability to tolerate pain and emotional responses to pain (e.g., anger, anxiety) may lead to the abuse of opioids to attempt to avoid these sensations. The proposed study will examine whether distress intolerance is associated with the presence of opioid abuse in chronic pain patients. Additionally, it will test whether intolerance of distress leads to greater sensitivity t pain, stronger emotional responses to pain, and greater craving for opioids when experiencing pain. Patients receiving long- term opioid therapy for chronic pain conditions in a pain management clinic will be administered measures of distress intolerance and opioid abuse, and will undergo testing of pain sensitivity, emotional response to pain, and craving for opioids. The results from this study will provide important information on the nature of prescription opioid abuse and chronic pain, which can be used to develop strategies for monitoring, preventing and treating this common and disabling condition. PUBLIC HEALTH RELEVANCE: Prescription opioid abuse is highly prevalent among patients with chronic pain and is associated with significant distress and disability. This project aims to better understand mechanisms that may confer greater risk for the development of prescription opioid abuse in pain patients. The results of this study have the potential to inform monitoring, prevention, and treatment of this significant public health problem.